NEWTON-WELLESLEY HOSPITAL. Standard 4.6: Assessment and Evaluation of Treatment Planning Rectal Cancer

Transcription

1 NEWTON-WELLESLEY HOSPITAL Standard 4.6: Assessment and Evaluation of Planning Rectal Cancer Each year a physician member of the cancer committee conducts a study to ensure that diagnostic evaluation and treatment provided to patients is compliant with evidence based national treatment and is appropriate for AJCC stage including prognostic indicators. Review : Review of 2011 Rectal Cancers to determine that the diagnostic evaluation is adequate and the treatment plan is concordant with NCCN Work-up : Each case assessed for colonoscopy, chest/abdominal/pelvic CT, pre-op, Endorectal ultrasound (EUS) or pelvic. Report of cancer related family history referral to genetic counseling when appropriate. Work-up assessment: 2/14 cases did not meet work-up. One 75 year old - Stage 1 (pt1 cn0m0) had no CT Chest/Abd/Pelvis and no pre-op. One 94 year old - Stage 3B (pt3n1cm0) did not get pre-op, endoscopic ultrasound, and had no up-front oncology consult. Patient s cancer recurred and then patient received palliative chemo. 12/14 met work-up assessment. Assessment: 2/14 cases did not meet treatment. One 94 year old Stage 2A (ct3n0m0) refused surgery and agreed only to palliative chemotherapy. Another 94 year old Stage 3B (pt3n1m0) refused adjuvant chemo and radiation and agreed only to surgery. 12/14 were concordant with NCCN Clinical Practice Guidelines in Oncology. Additional assessment: s were also reviewed for presentation at multidisciplinary GI conference, nutritional assessment, and consultation with Patient Navigator and medical oncology consultation. All patients except the insitu case and one 94 year old had an oncology consult. 13/14 patients were presented at Multidisciplinary GI Conference. 9/14 patients had nutritional assessments. 6/14 patients had a consult with the Patient Navigator.

2 NEWTON-WELLESLEY HOSPITAL Standard 4.6: Assessment and Evaluation of Planning Rectal Cancer Criteria for genetic counseling in Rectal Cancer cases defined as follows: Young patients (<50) regardless of any family history Patients older than (>50) who have 3 relatives (1 st, 2 nd or 3 rd degree) with family history of colorectal cancer Patients with history of multiple polyps Summary: Overall we are doing well with pre-op staging and evaluation Continue to encourage the multidisciplinary approach to rectal cancer Need to increase nutritional assessments Recommend rectal cancer patients to see Patient Navigator Continue to reinforce the need to follow NCCN Advanced age and comorbidities need to be considered when following Present evaluation at an upcoming GI cancer conference to reinforce

3 Rectal Cancer s - (Class of : 00 22, diagnosed and/or DIAGNOSTIC EVALUATION PER NCCN GUIDELINES Patient Class Colonoscopy CT Chest Age at Of Performed Abd/Pelvis Diagnosis EUS or 1 Age: /22/10 no no no FH Neg Polypectomy In situ GI CONF (benign YES polyp) 2 Age: /17/11 no no 5/25/11 FH Neg Polypectomy YES pt1 cn0m0 Oncology EUS & re-exc Stage 1 Consult Nutrition (neg) GI CONF Screening 3 Age: /10/11 8/17/11 Yes - neg 8/18/11 Mat Grf Low ant pt2n0m0 Oncology EUS Colon CA in resection YES Stage 1 Consult his 80 s 0/14 lns GI CONF No counseling 4 Age: /24/11 8/28/11 Yes - neg Colorectal FH Neg Transanal pt1 cn0m0 Oncology PET resection YES Stage 1 Consult GI CONF 5 Age: /1/11 2/2/11 Yes-elev 2/9/11 FH Neg Chemo ct3n0m0 Oncology EUS only NO Stage 2A Consult Colorectal Nutrition PT refused Pt refused GI CONF PET Screening surgery surgery

4 Patient Age at Diagnosis Class Of Colonoscopy Performed CT Chest Abd/Pelvis EUS or 6 Age: /11/11 3/22/11 Yes - pos 3/11/11 FH Neg Lap pt3n0cm0 Oncology EUS Nutrition Colectomy YES Stage 2A Consult screening Chemo & xrt 0/13 lns GI CONF Pt Navigator 7 Age: /16/11 3/18/11 Yes - neg 3/17/11 FH Neg Pre-op & pt3n0cm0 Oncology EUS Nutrition scr. post-op YES Stage 2A Consult coun chemo, xrt & 0/14 lns GI CONF Social work Lap AP Pt Navigator resection 8 Age: /1/11 7/14/11 Yes - pos 7/7/11 Mother Colon Pre-op & ct3n0m0 Oncology EUS CA Post-op YES Stage 2A Consult 7/21/11 Nutrition scr chemo, xrt, ypt2n0 GI CONF PET No resection 0/31 lns consult Pt Navigator 9 Age: /1/11 8/23/11 Yes - neg 9/1/11 FH Neg Pre-op & ct4bn0m0 Oncology EUS Nutrition scr post-op YES Stage 2C Consult 9/15/11 Pt Navigator chemo, xrt ypt3n0 GI CONF PET APresec. 0/16 lns 10 Age: /22/11 12/15/11 Yes - neg 10/11/11 FH Neg Low ant ct2n0m0 Oncology EUS Pt Navigator resection YES pt2n1b Consult Chemo & xrt Stage 3A GI CONF 2/13 lns

5 Patient Age at Diagnosis Class Of Colonoscopy Performed CT Chest Abd/Pelvis US or 11 Age: /28/11 3/29/11 Yes-neg 3/28/11 FH Neg Pre & post- ct3ypn1m0 Oncology EUS Nutrition Op chemo, YES Stage 3B Consult Abd Pt pre-op xrt, 1/17 lns GI CONF Navigator Lap Procte 12 Age: /29/11 4/11/11 No preop no FH Neg Colectomy pt3n1m0- Recurrence No Pt refused N0 stage 3B 8/13/12 Oncology adj chemo Pt refused 1/13 lns Tx Chemo Consult &xrt chemo & GI CONF xrt 13 Age: /3/11 7/5/11 Yes - neg 6/21/11 Mother Pre & post- ct3n1m0 Oncology EUS Rectal CA op chemo, YES stage 3B Consult 7/5/11: Nutrition sc xrt and yp T0N0 GI CONF PET colectomy 0/16 lns counseling 14 Age: /14/11 7/29/11 Yes-pos 7/22/11 FH Chemo ct3n0m1 Oncology EUS paternal only YES Stage 4A Consult PET Cousin NO GI Nutrition CONF screening Physician Reviewer: J. Wisch, MD, Chairman Cancer Care Committee Date Reviewed: 10/18/12 Date Reported to Cancer Committee: 11/15/12